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Issue 1430: June 12, 2019








Total number of U.S. measles cases for 2019 climbs to 1,022 with 41 new cases reported since last week

CDC has posted its latest update on 2019 measles cases in the U.S. on its Measles Cases and Outbreaks web page. The web page shows a preliminary estimate of 1,022 cases across 28 states as of June 6. This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated from the U.S. in 2000.

The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia, and Washington.

Access additional information about U.S. measles cases in 2019 on CDC's Measles Cases and Outbreaks web page.

Click on the following links for information about specific outbreaks:

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As measles cases surpass 1,000, HHS Secretary Alex Azar issues statement reinforcing commitment to vaccination as part of HHS news release

On June 5, Health and Human Services Secretary Alex Azar issued a statement as part of an HHS news release announcing that measles cases in the U.S. have surpassed 1,000 this year. His statement is reprinted below.

“The Department of Health and Human Services has been deeply engaged in promoting the safety and effectiveness of vaccines, amid concerning signs that there are pockets of undervaccination around the country. The 1,000th case of a preventable disease like measles is a troubling reminder of how important that work is to the public health of the nation. The Centers for Disease Control and Prevention, alongside others across HHS, will continue our efforts to support local health departments and healthcare providers in responding to this situation, with the ultimate goal of stopping the outbreak and the spread of misinformation about vaccines, and increasing the public’s confidence in vaccines to help all Americans live healthier lives, safe from vaccine-preventable diseases.

“We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak. The measles vaccine is among the most-studied medical products we have and is given safely to millions of children and adults each year. Measles is an incredibly contagious and dangerous disease. I encourage all Americans to talk to your doctor about what vaccines are recommended to protect you, your family, and your community from measles and other vaccine-preventable diseases.”

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May's Technically Speaking column by IAC executive director titled "How to Protect Children, Adults, and Healthcare Personnel from Measles" now available on IAC's website 

Technically Speaking is a monthly column written by IAC Executive Director Dr. Deborah Wexler for Vaccine Update for Healthcare Providers, a monthly e-newsletter from the Vaccine Education Center at the Children's Hospital of Philadelphia (CHOP). 

May's column, titled "How to Protect Children, Adults, and Healthcare Personnel from Measles," is now available on IAC's Technically Speaking web section and is reprinted below.

How to Protect Children, Adults, and Healthcare Personnel from Measles

In the U.S., we are currently experiencing measles outbreaks in 23 states, with 839 individual cases confirmed between January 1 and May 10, 2019. This is the greatest number of cases reported in the U.S. in a single year since 1994 and since measles was declared eliminated in 2000. Most of the people getting infected are unvaccinated.

Many vulnerable people in our communities are unvaccinated because they are too young for vaccination or have medical conditions like cancers and immune system disorders for which MMR vaccination is contraindicated. For their protection, these individuals must rely on those around them having high MMR vaccination coverage rates.

We can help stop these outbreaks and heighten community immunity. Make sure your patients, their families, and healthcare personnel (HCP) are protected by following the measles vaccination recommendations of CDC's Advisory Committee on Immunization Practices (ACIP), briefly described below.

Protecting Children from Measles

Two doses of MMR vaccine are routinely recommended for children. The first dose is given at age 12–15 months and the second dose at age 4–6 years. But instead of waiting until age 4–6 years, the second dose may be given as soon as 4 weeks (28 days) after the first dose and still be counted as a valid dose if both doses were given after the child's first birthday. Giving the second dose as early as 4 weeks after the first dose should be considered in communities where measles is circulating. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to respond to the first dose.

MMR vaccine may be administered to infants as young as age 6–11 months who are at high risk of exposure. This includes international travelers, as well as infants living in communities experiencing measles outbreaks. Consult your local or state health department to find out if this is recommended in your community. If you give a dose of MMR vaccine to an infant before the first birthday, it does not count as part of the routine 2-dose MMR series. The first dose should be repeated when the child is age 12 months.

Protecting Adults from Measles

For adults born before 1957

Adults born before 1957 can be assumed to be immune to measles. This includes international travelers and students, but it does not necessarily apply to healthcare personnel (HCP). Healthcare facilities should consider vaccinating unvaccinated HCP born before 1957 who do not have laboratory evidence of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine. CDC recommends that, during an outbreak of measles, healthcare facilities should recommend 2 doses of MMR vaccine at the appropriate interval for unvaccinated HCP who lack laboratory evidence of measles immunity, regardless of birth year.

For adults born in 1957 or later

Adults born in 1957 or later should receive at least 1 dose of MMR vaccine unless they have acceptable evidence of immunity (i.e., 1 documented dose of MMR or a measles-containing vaccine, laboratory evidence of immunity, or laboratory confirmation of disease).

Certain adults born in 1957 or later may need 2 doses. Adults who are going to be in a setting that poses a high risk for measles transmission should make sure they have had 2 doses separated by at least 28 days. These adults include:

  • students at post-high school education institutions;
  • healthcare personnel;
  • international travelers; and
  • people who public health authorities determine are at increased risk for getting measles during a measles outbreak.
People who previously received a dose of MMR vaccine between 1963–1967 and are unsure which type of vaccine (live or inactivated measles vaccine) was used, or who are sure it was inactivated measles vaccine, should be revaccinated with either 1 dose (if low risk) or 2 doses (if high risk) of MMR vaccine.

If a person born in 1957 or later has no documentation of MMR, you could check the patient's blood for a measles titer; however, commercial tests currently available are not sensitive enough to reliably detect vaccine-induced immunity, leading to false negatives. In addition, this step will require an extra office visit and add to the cost. There is no harm in receiving 1 or 2 doses of MMR vaccine if a person is already immune to measles (or mumps or rubella). ACIP does not recommend testing for immunity after appropriate MMR vaccination.

On May 17, CDC released a "Dear Provider" letter discussing what clinicians need to know about protecting adult patients from measles.

During this time of outbreaks in so many states with case counts climbing week after week, it's important to make sure your patients are protected from this highly contagious virus.

You can access the current and past issues of Technically Speaking in the following ways: from a box in the middle of the home page, from the "Guide to" at the bottom of every web page, or by going directly to the home page.

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New York Times publishes opinion piece titled “When Defending Vaccines Gets Ugly”
On June 2, the New York Times published an opinion piece titled When Defending Vaccines Gets Ugly: Dr. Peter Hotez has devoted his career to making vaccines more widely available. He routinely gets attacked for it. Selections from this piece are reprinted below.

Peter Hotez is no stranger to vitriol. An outspoken proponent of vaccines in a state with one of the most vocal anti-vaccine lobbies in the country, Dr. Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas, has been harassed at lectures, threatened online and blamed for his daughter’s autism.

In early May, he took to Twitter to lament a report from the Texas health department showing a 14 percent increase in the number of parents seeking vaccine exemptions in the state. In response, State Representative Jonathan Stickland accused Dr. Hotez of being in the drug industry’s pocket and referred to his science as self-serving “sorcery.”

“It’s one thing to have emotional parents or angry activists coming after you,” Dr. Hotez says. “It’s really quite another to get it from elected officials.”

Attacks on scientists who defend vaccines are nothing new. In the late 1990s and early 2000s, Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia, received so many credible death threats resulting from his pro-vaccine advocacy that the F.B.I. assigned him a bodyguard.

Read the complete opinion piece: When Defending Vaccines Gets Ugly: Dr. Peter Hotez has devoted his career to making vaccines more widely available. He routinely gets attacked for it.

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2019 National Conference for Immunization Coalitions and Partnerships scheduled for November 13–15 in Honolulu; abstract deadline has been extended to June 30

The 14th National Conference for Immunization Coalitions and Partnerships, Navigating from Local to Global, will take place in Honolulu from November 13–15. This is a great opportunity for coalition members and others to learn from expert speakers and network with members of immunization coalitions from around the nation.

The planners are accepting abstract submissions for breakout sessions and posters and the deadline has been extended to June 30. Abstracts are welcome from representatives of all disciplines, including coalition staff and members, community-based providers, healthcare providers, social workers, researchers, government agencies, health communication specialists, and others. 

Please register by August 31, 2019, to receive the early bird rates.

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IAC Spotlight! IAC’s Immunization Partners web page features organizations that work with IAC

The IAC Immunization Partners web page features a listing of governmental and nonprofit organizations as well as professional societies that work in the field of immunization in the U.S. The current list includes partners with whom IAC has worked over the years. The alphabetical list includes short descriptions and links to the organizations' websites, as well as links to other specific resources or information on their sites. We recognize that some organizations may have been inadvertently omitted. Please let us know if your organization should be added to this web page.

Check out the IAC Immunization Partners web page to learn more.

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Nominations for the 2020 NFID Awards to recognize leaders and heroes of public health are due July 1

The National Foundation for Infectious Diseases (NFID) is soliciting nominations for the 2020 Jimmy and Rosalynn Carter Humanitarian and Maxwell Finland Scientific Achievement awards. These annual awards honor outstanding individuals working to help achieve the NFID vision of a world where people live healthier lives through effective prevention and treatment of infectious diseases.
Please take this opportunity to nominate a deserving colleague who has made significant and lasting contributions to public health through scientific achievement, philanthropy, and/or legislation. Selected awardees will be recognized at the 2020 NFID Awards Dinner in Washington, DC next spring.
The deadline for nominations is July 1. Access information on the award categories and online nomination form.

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CDC publishes “Progress Toward Measles Elimination—Pakistan, 2000–2018” in this week's MMWR

CDC published Progress Toward Measles Elimination—Pakistan, 2000–2018 in the June 7 issue of MMWR (pages 505–510). The first paragraph of the MMWR article is reprinted below.

In 1997, the 21 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) passed a resolution during the 41st session of the Regional Committee for the Eastern Mediterranean to eliminate measles. In 2015, this goal was included as a priority in the Eastern Mediterranean Vaccine Action Plan 2016–2020, approved at the 62nd session of the Regional Committee. To achieve measles elimination, the WHO Regional Office for the Eastern Mediterranean developed the following four-pronged strategy: 1) achieve ≥95% vaccination coverage with the first dose of measles-containing vaccine (MCV) among children in every district of each country through routine immunization services; 2) achieve ≥95% vaccination coverage with a second MCV dose in every district of each country either through implementation of a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs); 3) conduct high-quality, case-based measles surveillance in all countries; and 4) provide optimal measles clinical case management, including dietary supplementation with vitamin A. Pakistan, an EMR country with a population of approximately 200 million, accounts for nearly one third of the overall EMR population. This report describes progress and challenges toward measles elimination in Pakistan during 2000–2018. During the study period, estimated coverage with the first MCV dose (MCV1) increased from 57% in 2000 to 76% in 2017. The second MCV dose (MCV2) was introduced nationwide in 2009, and MCV2 coverage increased from 30% in 2009 to 45% in 2017. During 2000–2018, approximately 232.5 million children received doses of MCV during SIAs. Reported confirmed measles incidence increased from an average of 24.6 per 1 million persons during 2000–2009 to an average of 80.4 during 2010–2018, with peaks in 2013 (230.3) and 2018 (153.6). In 2017 and 2018, the rates of suspected cases discarded as nonmeasles after investigation were 2.1 and 1.5 per 100,000 population, reflecting underreporting of cases. To achieve measles elimination, additional efforts are needed to increase MCV1 and MCV2 coverage, develop strategies to identify and reach communities not accessing immunization services, and increase sensitivity of case-based measles surveillance in all districts.

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CDC’s Resources for Health Care Providers web section offers a variety of tools on vaccine administration, safety, and more

CDC has developed a comprehensive web section of immunization resources to help support healthcare professionals. CDC’s Resources for Health Care Providers web section offers a variety of immunization resources which are described below.
Be sure to check out the information and printable materials available at CDC’s Resources for Health Care Providers web section.

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Hepatitis B Foundation releases “Randy's Story” to raise awareness about discrimination in the U.S. armed forces against those living with chronic hepatitis B

The Hepatitis B Foundation continues its storytelling campaign: #justB: Real People Sharing their Stories of Hepatitis B

Watch the June video, Randy’s Story, about a father (Randy) whose excitement over his son Cody’s acceptance to the U.S. Naval Academy turned to disappointment when they learned that Cody had chronic hepatitis B virus infection. Even though monitoring and treatment have advanced considerably, according to the video, the U.S. military does not admit people with the virus. Randy hopes this policy can be changed, and he continues to support Cody in moving on and embracing a hopeful future.

Watch any of the following new videos by going to the web section: #justB: Real People Sharing their Stories of Hepatitis B

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Still available! IAC’s sturdy laminated 2019 U.S. child/adolescent immunization schedules—order some for your exam rooms today! Bulk purchase prices available.

IAC's laminated 2019 U.S. child/adolescent immunization schedule is still available. The adult schedules have sold out. These schedules are covered with a tough coating you can wipe down; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. The child/adolescent schedule is eight pages (i.e., four double-sided pages) and is folded to measure 8.5" x 11". 

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading. They come complete with essential tables and notes, and they replicate the newly designed CDC schedule format.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email

You can access specific information on the schedule, view an image, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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IAC's 142-page book, Vaccinating Adults: A Step-by-Step Guide, describes how to implement adult vaccination services in your healthcare setting and provides a review for staff who already vaccinate adults; IAC Guide available for free download

In late 2017, the Immunization Action Coalition (IAC) announced the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).

This completely updated "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting. Topics include:

  • setting up for vaccination services,
  • storing and handling vaccines,
  • deciding which people should receive which vaccines,
  • administering vaccines,
  • documenting vaccinations (including legal issues), and
  • understanding financial considerations and billing information.

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

The entire Guide is available to download/print free of charge at The downloaded version is suitable for double-sided printing. Options are available online to download the entire book or selected chapters. The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.

The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!

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CDC offers webinar archive for clinicians titled “Most Measles Cases in 25 Years: Is This the End of Measles Elimination in the United States?”
CDC is offering an archive of its Clinical Outreach and Communication Activity (COCA) webinar which originally aired on May 21, 2019. Titled Most Measles Cases in 25 Years: Is This the End of Measles Elimination in the United States?, CDC has provided the following description of this session:

During this COCA Call, clinicians will learn what makes 2019 a historic year for measles and what they can do to help identify cases and stop measles transmission.

Free continuing education credits (CME, CNE, CEU, CECH, and CPE) are available. 

Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs June 5 through September 25; register now

CDC is again presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that started June 5 and will run through September 25. The June 12 webinar is titled "General Best Practice Guidelines, Part 1" and the June 19 webinar is titled "General Best Practice Guidelines, Part 2, and Vaccine Safety."

Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.

The webinar series will provide an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.

Registration and more information is available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at

You can also order this resource from the Public Health Foundation for $40 plus shipping and handling.

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NFID offers June 19 webinar on managing outbreaks of vaccine-preventable diseases

The National Foundation for Infectious Diseases (NFID) will present a webinar titled Managing Outbreaks of Vaccine-Preventable Diseases on June 19 at 12:00 p.m. (ET). NFID medical director William Schaffner, MD will moderate the webinar with presentations by Ruth Carrico, PhD, DNP, FNP-C, CIC, associate professor, University of Louisville; and Jane Zucker, MD, MS, assistant commissioner, New York City Department of Health and Mental Hygiene, Bureau of Immunization. Presentations will focus on sharing strategies and best practices implemented during recent outbreaks of hepatitis A and measles.
Registration information

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NACCHO to offer 5-part webinar series on public health communications; first session on “Principles to Address Vaccine Resistance and Hesitancy” scheduled for June 13

The National Association of County and City Health Officials (NACCHO) will offer a multi-part webinar series to help local health departments build capacity to engage in public health communication. The webinar topics were selected based on a two-part needs assessment that NACCHO conducted in 2017–2018 to determine local health departments’ communications capacity, capabilities, and skills gaps. These webinars are open to all public health professionals. Non health department staff are welcome to attend.

Join one or more of these sessions to learn about public health communications. The webinars will cover:

Click on any of the links above for more information about a session. You will need to register for each webinar individually. All webinars will be recorded for on-demand viewing.

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Tune in to CDC's ACIP meeting June 26–27 (Wednesday and Thursday) via live webcast

Tune in to the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta on June 26 and 27 (Wednesday and Thursday) via live webcast.

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About IAC Express
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IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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